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2004 International Society of Hair Restoration Surgery conference
Article by James A. Harris, MD.
Hair Sciences Center of Colorado
New Instrumentation and Methodology to Improve Follicular Unit Extraction: Less Transection, Higher Rate of Graft Production, Expanded Patient Candidacy
Introduction
The technique of follicular unit extraction (FUE) and the FOX test as described by Dr's Rassman and Bernstein, has added an additional technique to the armamentarium of the hair transplant surgeons. However, the technique is technically demanding and time consuming and there is the possibility of high rates of transection. In the study by Rassman, Bernstein, et al, 37.5% of patients were FOX negative (not candidates for FUE) due to high rates of follicle damage. Even for FOX positive patients (candidates for the procedure), the rate of follicle transection may be as high as 20%. The technique, as is currently described, may consume the better part of the day to extract and implant 1,000 grafts.
Some of the factors related to the high follicle transection rate are curvature of the follicle below the epidermis, and excessive tethering of the follicle to the sub dermal tissue by connective tissue components. The author of this report has devised a methodology and surgical instrumentation to address these problems that has resulted in a reduction of the transection rate, an increase in the speed of extraction, and an expansion of patient candidacy.
Objective
To present the surgical methodology and instrumentation that, when applied to FUE, will result in minimal transection rates, expand patient candidacy, and significantly increase extraction rates.
Materials and Methods
Several cases of FUE with the new methodology and instrumentation are documented with still photography and video. Graft production and transection rates are calculated and recorded. An evaluation of patient candidacy based on transection rates of different hair types 9straight, curly, gray/white) will be presented.
Discussion / Results
Eight patients (at the time of this abstract) have been subjects of this new methodology and instrumentation. It is anticipated that the number may double by the time of presentation in August. The range of grafts extracted in this series has been between 50 and 800 grafts; sessions up to 1500 and 2000 grafts have been scheduled. Transection rates of hair follicles have ranged from 0% to 8% thus far. All patients so far would be considered FOX positive, as the transection rate is significantly less than 20% in all cases. The lowest extraction rate, our first case, was approximately 200 grafts per hour. Extrapolation on several subsequent cases revealed a 0% transection rate. The technique was taught to surgical assistants without difficulty and mastered within minutes.
Conclusion
This novel, efficient, and easily mastered methodology for FUE compares favorably to, if not better than, traditional microscopic dissection. Transection rates are comparable to, or less than, microscopic dissection in most patients and the rates are significantly less than traditional FUE. Graft production rates with this new technique are also significantly higher than traditional FUE methodology. This new technique has the capability to expand patient candidacy for FUE to virtually 100% of patients, including African Americans and those with gray hair. Because of these enhancements to traditional FUE, the advantages to be gained by FUE will now become available to the average practitioner.
James A. Harris, MD.
Article by James A. Harris, MD.
Hair Sciences Center of Colorado
New Instrumentation and Methodology to Improve Follicular Unit Extraction: Less Transection, Higher Rate of Graft Production, Expanded Patient Candidacy
Introduction
The technique of follicular unit extraction (FUE) and the FOX test as described by Dr's Rassman and Bernstein, has added an additional technique to the armamentarium of the hair transplant surgeons. However, the technique is technically demanding and time consuming and there is the possibility of high rates of transection. In the study by Rassman, Bernstein, et al, 37.5% of patients were FOX negative (not candidates for FUE) due to high rates of follicle damage. Even for FOX positive patients (candidates for the procedure), the rate of follicle transection may be as high as 20%. The technique, as is currently described, may consume the better part of the day to extract and implant 1,000 grafts.
Some of the factors related to the high follicle transection rate are curvature of the follicle below the epidermis, and excessive tethering of the follicle to the sub dermal tissue by connective tissue components. The author of this report has devised a methodology and surgical instrumentation to address these problems that has resulted in a reduction of the transection rate, an increase in the speed of extraction, and an expansion of patient candidacy.
Objective
To present the surgical methodology and instrumentation that, when applied to FUE, will result in minimal transection rates, expand patient candidacy, and significantly increase extraction rates.
Materials and Methods
Several cases of FUE with the new methodology and instrumentation are documented with still photography and video. Graft production and transection rates are calculated and recorded. An evaluation of patient candidacy based on transection rates of different hair types 9straight, curly, gray/white) will be presented.
Discussion / Results
Eight patients (at the time of this abstract) have been subjects of this new methodology and instrumentation. It is anticipated that the number may double by the time of presentation in August. The range of grafts extracted in this series has been between 50 and 800 grafts; sessions up to 1500 and 2000 grafts have been scheduled. Transection rates of hair follicles have ranged from 0% to 8% thus far. All patients so far would be considered FOX positive, as the transection rate is significantly less than 20% in all cases. The lowest extraction rate, our first case, was approximately 200 grafts per hour. Extrapolation on several subsequent cases revealed a 0% transection rate. The technique was taught to surgical assistants without difficulty and mastered within minutes.
Conclusion
This novel, efficient, and easily mastered methodology for FUE compares favorably to, if not better than, traditional microscopic dissection. Transection rates are comparable to, or less than, microscopic dissection in most patients and the rates are significantly less than traditional FUE. Graft production rates with this new technique are also significantly higher than traditional FUE methodology. This new technique has the capability to expand patient candidacy for FUE to virtually 100% of patients, including African Americans and those with gray hair. Because of these enhancements to traditional FUE, the advantages to be gained by FUE will now become available to the average practitioner.
James A. Harris, MD.
